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Case Study for TWiP 148

Will have a guest on next show to unveil! Female teenager living in NYC, previously in good health, rash for 2 week, abnormal feeling in legs. Initially had URT infection, no cough or fever. Rash is itchy, worse at night. But feeling of pins and needles, sharp stabbing in feet and legs. In ER told is zoster, started on gabapentin. Few days later fevers, pain getting worse. Seen by neurologist and ID doc, admitted. No past med/surg. Type 1 diabetes in aunt, father migraines, no autoimmune diseases. Had received chickenpox vaccine! Social: lives with parents and younger brother, much travel, Holland, Hawaii, most recent, pet lizard. In Hawaii, salad that she ate but no one else. Physical: febrile, heart rate >110, bp ok. Does not want to move because of pain. Neurological: extremity movement is slow. Rash irregular on chest, neck, back, abdomen. Labs: white normal, not much shift. Sed: 24, slightly increased. Lumbar puncture: increased white cells 280, 32% eosinophils.